DHHR, Cabell create WV’s first needle-exchange pilot

HUNTINGTON, W.Va. — So far in 2015, Cabell County has collectively lost more than 1,000 years of productive life among its citizens at the hands of an epidemic that has swept the entire Mountain State.

“Make no mistake about it — we are in the midst of a serious health crisis in our community,” Huntington Mayor Steve Williams said. “The fact that we’re taking aggressive steps to move forward is not something for us to go boast about, simply because this is a crisis, but we have to act.”

The epidemic is illegal-drug overdoses, and the county’s latest response hopes to curb use while tackling another big problem — West Virginia’s skyrocketing rates of hepatitis B and C.

After months of discussion with community and state partners, the Cabell-Huntington Health Department, the West Virginia Department of Health and Human Resources and the city of Huntington have launched the state’s first syringe-exchange program. In Huntington on Thursday, the DHHR announced that it will provide $10,000 in funding, plus an additional $10,000 in in-kind technical support to Cabell County’s pilot program.

“It really is a partnership, and I think that’s one of the most critical elements we’re talking about — the idea that all of us are in the same room with the same goals, trying to make a difference in the lives of the people in the state of West Virginia,” DHHR Cabinet Secretary Karen Bowling said. “It’s something we should all be committed to throughout the entire state, because we do know there’s a significant problem with this.”

Hepatitis B and C are viral infections that can cause chronic and acute liver damage. In West Virginia, 10.6 cases of hepatitis B per 100,000 people were reported in 2013, well above the national average of 0.9 cases per 100,000 people, according to the DHHR.

Even as the national average has dropped, the rate has increased in West Virginia over the past four years from 4.7 in 2010 to 6.1 in 2011 and 7.6 in 2012. The rate of hepatitis C in also is concerning — in 2013, 3.1 cases per 100,000 people were reported in West Virginia, compared to 0.7 cases per 100,000 people across the country. In a May study, the Centers for Disease Control and Prevention found that hepatitis C cases in four Appalachian states — Kentucky, Tennessee, Virginia and West Virginia — more than tripled between 2006 and 2012.

Needle-exchange programs offer free sterile syringes and collect used syringes from injection-drug users, to reduce the spread of blood-borne pathogens, including HIV, hepatitis B and hepatitis C. Multiple studies have documented that they reduce the risk of HIV infection among injection-drug users and their partners, according to Dr. Rahul Gupta, commissioner for the Bureau for Public Health and state health officer.

“As a taxpayer, you’d better believe that everyone has a reason to be concerned about this, because the cost of treating the HIV, the hepatitis B, the hepatitis C, has tried our state budget to the maximum,” said Dr. Matthew Rohrbach, a Republican member of the House of Delegates representing Cabell County. “When we looked around the country, and we looked no further than our friends in Portsmouth, Ohio — we visited with them to find out what they did. They started a needle-exchange program, and within six months of someone going to the Portsmouth needle-exchange program, they found out that 50 percent of the people said, ‘By the way, could you help me get off this? Could you get me some help?’

According to Gupta, 3,000 West Virginians have died from overdoses in the past five years, and 450 of those deaths can be attributed to heroin, an increasingly popular drug of choice among intravenous drug users. Because heroin metabolizes into morphine in the body, Gupta said, there’s a good chance heroin overdoses are underreported. Similarly, cases of diseases like HIV and hepatitis B and C, which can remain asymptomatic for years after exposure, are likely also underreported.

“Hepatitis is much more infectious than HIV, and add to that the fact that, for either of these diseases, you may have the disease and initially not have the disease presentation for many years, during which you could be spreading to multiple other partners and others in the community through IV drug use and sexual transmission,” Gupta said. “Add to that the burden of being an addict, and it just complicates exponentially the challenge of facing those diseases.”

Dr. Michael Kilkenny, health director of the Cabell-Huntington Health Department, said the agency is seeking additional funds to launch the pilot, which he anticipates will be fully operational by September.

Kilkenny estimated that a full-fledged pilot will cost about $250,000 to run for a year — money he says will easily be recouped by the savings estimated in preventing diseases like hep B and C. Kilkenny said that, if Cabell County can reduce its incidence of hepatitis B and C by 50 percent in the first year, it will save $1.3 million.

“There are a myriad of diseases associated with dirty needles, including bacterial endocarditis, a heart valve infection — those cases can rack up hundreds of thousands of dollars each in costs,” Kilkenny said. “For every one of those we prevent, we can justify the cost of this program for another year.”

According to Williams, the goal of the program is “not to arrest people, but to save people.” Kilkenny added that the Health Department and the county plan to ramp up efforts to remove used needles from the surrounding community and incorporate the needle-exchange in a comprehensive harm-reduction strategy for the department that includes education, referrals, health screenings and hepatitis B vaccinations.

“The point is not to heap praises on ourselves for stepping forward; we would rather not be in this position,” Williams said. “This is an epidemic that tries our souls. We are losing people at a rate that is certainly unacceptable. If there is anything we can point to that is reflective of the people in our community and of West Virginia, it’s that what is in our DNA is that, when there is trouble in the community, we come together.”

Reach Lydia Nuzum at lydia.nuzum@wvgazette.com, 304-348-5189 or follow @lydianuzum on Twitter.

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